Fraunhofer-Institut für Produktionsanlagen und Konstruktionstechnik IPK

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User-centered design of a patient's work station for haptic robot-based telerehabilitation after stroke

2017 , Ivanova, E. , Minge, M. , Schmidt, H. , Thüring, M. , Krüger, J.

Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient's work station as part of a novel robot-based system for motor telerehabilitation.

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Richtlinien für die Gestaltung von visuellem Biofeedback in der neurologischen Gangrehabilitation nach Schlaganfall

2010 , Brüning, M. , Hussein, S. , Bardeleben, A. , Schmidt, H. , Krüger, J. , Hesse, S.

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Gait rehabilitation machines based on programmable footplates

2007 , Schmidt, H. , Werner, C. , Bernhardt, R. , Hesse, S. , Krüger, J.

Background: Gait restoration is an integral part of rehabilitation of brain lesioned patients. Modern concepts favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk, while tone-inhibiting and gait preparatory manoeuvres had dominated therapy before. Following the first mobilization out of the bed, the wheelchair-bound patient should have the possibility to practise complex gait cycles as soon as possible. Steps in this direction were treadmill training with partial body weight support and most recently gait machines enabling the repetitive training of even surface gait and even of stair climbing. Results: With treadmill training harness-secured and partially relieved wheelchair-mobilised patients could practise up to 1000 steps per session for the first time. Controlled trials in stroke and SCI patients, however, failed to show a superior result when compared to walking exercise on the floor. Most likely explanation was the effort for the therapists, e. g. manually setting the paretic limbs during the swing phase resulting in a too little gait intensity. The next steps were gait machines, either consisting of a powered exoskeleton and a treadmill (Lokomat, AutoAmbulator) or an electromechanical solution with the harness secured patient placed on movable foot plates (Gait Trainer GT I). For the latter, a large multi-centre trial with 155 non-ambulatory stroke patients (DEGAS) revealed a superior gait ability and competence in basic activities of living in the experimental group. The HapticWalker continued the end effector concept of movable foot plates, now fully programmable and equipped with 6 DOF force sensors. This device for the first time enables training of arbitrary walking situations, hence not only the simulation of floor walking but also for example of stair climbing and perturbations. Conclusion: Locomotor therapy is a fascinating new tool in rehabilitation, which is in line with modern principles of motor relearning promoting a task-specific repetitive approach. Sophisticated technical developments and positive randomized controlled trials form the basis of a growing acceptance worldwide to the benefits or our patients.

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Design of a pressure sensitive matrix for analyzing direct haptic patient-therapist interaction in motor rehabilitation after stroke

2017 , Pust, M. , Ivanova, E. , Schmidt, H. , Krüger, J.

Robot based therapy is one of the prevalent therapeutic approaches in motor stroke rehabilitation. It is often used in hospitals in combination with conventional therapy. In order to optimize human-robot interaction, we aim to investigate how a therapist physically supports patients during motor training of the upper extremities. This paper presents the design of a flexible textile sensor matrix, which measures the pressure exerted between therapist and patient during direct haptic interaction as well as the hand position and orientation in space. The matrix contains 144 sensors which enables measuring pressure intensity and localization of areas where the pressure is applied. The measurement matrix was evaluated with four healthy participants.

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Structural analysis method for optimized design of complex kinematic structures using static and dynamic models and application to a robotic walking simulator

2010 , Brüning, M. , Hussein, S. , Schmidt, H. , Krüger, J.

This paper describes an approach for structural analysis for design improvements of complex, e.g. hybrid, kinematic structures utilizing static and dynamic models. It is suitable to locate improvement potentials in existing mechanisms, facilitate goal-oriented design of new mechanisms or for a simulation-based controller synthesis e.g. a compliance-controller. To receive a model close to reality, mechanical influences, which are commonly neglected in conventional robot models, are analyzed regarding their relevance and if suitable integrated into the model. Investigated effects are the mechanical compliances of links and gears, compliances of the actuators resulting from the control circuits as well as non-linear frictional influences of the actuators. The kinematic and dynamic model is realized as an iterative solution instead of a closed analytic solution with extensive symbolic expressions. This leads to an analysis with clearly arranged aspects, further more the model is suitable for usage in a real-time control. The mechanical influences are analyzed analytically. The derived dynamic modeling is based on the Newton-Euler formulation. The approach is applied to the robotic walking simulator HapticWalker, a device for robot assisted gait rehabilitation. It consists of two identical hybrid parallel-serial manipulators. The forces calculated by the use of the developed model are in a good congruence with measured values. An obviously improved correspondence between measured and calculated values is achieved by the non-linear friction model of the actuators.

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Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation

2017 , Hoermann, S. , Santos, L.F. dos , Morkisch, N. , Jettkowski, K. , Sillis, M. , Devan, H. , Kanagasabai, P.S. , Schmidt, H. , Krüger, J. , Dohle, C. , Regenbrecht, H. , Hale, L. , Cutfield, N.J.

Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. Method: We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients.

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Visuelles Biofeedback für die gerätegestützte neurologische Gangrehabilitation nach Schlaganfall

2010 , Brüning, M. , Hussein, S. , Bardeleben, A. , Schmidt, H. , Krüger, J. , Hesse, S.

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